Microblading Pre-consult form

Microblading and shading Consent Form

Helium salon
Client Information
Name*

First NameLast Name
Age*
Birth Date*

MonthDayYear
Date
Phone Number*
Email*
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Pre-Procedure Questionnaire
Do any of the following pertain to you?*

Pregnant or nursingDiabeticSkin diseasesBotox in the last 2 monthsAccutane in the last 6 monthsBlood thinnersPain intolerantEpilepticAutoimmune diseaseCancer, Or had Chemo therapy or radiationHIVChemical Peels in the last monthHeart conditionsHepatitisKeloid scarsAlopeciaNone of the above
If you selected anything from above, please explain:
If yes, please identify the condition.
Would you consider your skin:*

Very oilyoilydrycombination
Do you have any previous permanent make up and or microblading on your eyebrows?*

yesno
Do you have a preferred artist?*

first availableRenataSierraKenley
Signed Date*

MonthDayYear
Date
Client Signature*

Clear

In order to book a consultation we do require a $50 deposit. Should you book a treatment with one of our artist the $50 will be applied to your deposit. However if you choose to not book an appointment the cost of the consultation is $50 and non refundable.
Please upload a picture of your eyebrows, with no make up on. *

Cancelof

Microblading and shading Consent Form